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A five-year-old boy developed primary tuberculosis of the conjunctiva which spread to the preauricular and cervical lymph nodes, producing caseous lymphadenitis. Because conjunctival tuberculosis is rare, the correct diagnosis may be easily missed. When unilateral conjunctivitis is accompanied by lymph node enlargement and persists or progresses, tuberculosis should be suspected.
Swabs of conjunctiva were collected from 44 live and 226 hunter-harvested mule deer (Odocoileus hemionus) from Wyoming and Utah (USA). We identified 29 gram negative and 22 gram positive bacterial taxonomic categories, but many isolates from hunter-harvested animals were environmental contaminants. Staphylococcus spp. and Micrococcus spp. were the most common gram positive bacteria isolated, and Enterobacter spp., Escherichia coli, and Pseudomonas spp. were common gram negative bacteria isolated. Thelazia californiensis were found in 15% of hunter-harvested deer in Utah in 1994 and in 8% in 1995. Nematodes were found in 40% of live deer in 1995 and 66% in 1996. Three live animals showed clinical signs of infectious keratoconjunctivitis (IKC) in 1996, but pathogenic bacteria were not isolated from these individuals. Hemolytic, non-piliated Moraxella ovis was isolated from two clinically normal live deer in 1996 and isolates were similar to those cultured from IKC cases from Wyoming and Utah.
Isolated comma or corkscrew-shaped venular segments in the conjunctiva have been felt to be diagnostic of sickle cell disease. External eye examination of a 34-year-old black man with a two-year history of chronic granulocytic leukemia revealed multiple small and medium-sized isolated conjunctival venular segments. Laboratory findings at the time of examination included a white blood cell count of 132,000/mm3 with 87% eosinophils, a hematocrit reading of 30%, and hemoglobin AA. Since whole blood hyperviscosity can be present in chronic granulocytic leukemia as well as sickle cell disease, this may account for the similarly of the conjunctival changes.
PURPOSE: The purpose of this study is to test the hypothesis that a subset of conjunctival melanocytic proliferations exists that cannot be reproducibly classified as benign, malignant, or indeterminate. METHODS: Three groups of excisional biopsy specimens of conjunctival melanocytic proliferations were evaluated by 5 ophthalmic pathologists. These groups included lesions that were considered by the authors to represent benign (Group 1, n = 5), malignant (Group 2, n = 5) and indeterminate melanocytic proliferations (Group 3, n = 5). The panel classified the same sections in all 3 groups in a randomized, masked fashion, first without and then with a clinical history of patient age, sex and race. The kappa statistic (k) was used to quantify the degree of agreement among observers. RESULTS: There was strong concordance among the panel for both Group 1 (benign, k = 0.76) and Group 2 (malignant, k = 0.70) melanocytic proliferations. There was no concordance of the panel for Group 3 (indeterminate) lesions (k = -0.045). The concordance for Groups 1 and 2 and lack of concordance for Group 3 lesions were independent of knowledge of clinical history of age, sex, and race. CONCLUSIONS: A subset of melanocytic proliferations of the conjunctiva exists that cannot be reproducibly classified by pathologists as benign, malignant, or indeterminate.
Although there are relatively few cases in our series of tumor of the conjunctiva, they represent most frequent histopathologic varieties for this localization. It is difficult to treat these patients in such a way as to cure the tumor while preserving intact the eye and vision. Surgery is recommended only in well differentiated cases that are diagnosed early. The excellent physical properties of strontium-90 make it particularly useful for this type of localization. High doses of radiation can be applied to the tumors with little danger to the deep and sensitive structures of the eye. With fractional doses we have been able to control conjunctival tumors of considerable size and thickness which would not normally have been considered tributary to this type of therapy.
PURPOSE: To assess whether the size of the cells obtained by conjunctival impression cytology can be quantitatively assessed by measurement of the longest dimension of the cells. METHODS: Under topical benoxinate anaesthesia, cells were removed from the normally exposed nasal bulbar conjunctival surface using a 0.4 micron pore diameter filter (Biopore filter; type Millcell-CM). The filters were stained with haematoxylin after ethanol denaturation, photographed at 40 x magnification, and 35 mm slides prepared. An optical overlay method was used to outline the borders of sets of 30-35 contiguous cells on each image. The cell area, longest and shortest dimensions were measured by planimetry to an accuracy of +/- 3%. RESULTS: Analyses of 20 sets of samples, from individuals aged 21 to 48 years and without clinically significant ocular surface disease, revealed a median cell area of 133 micron 2 (n = 621, range 46-1602 micron 2; average 212 micron 2), a median longest dimension of 13.9 microns (range 6.6-68.8 microns; average 16.9 microns) and a shorter dimension of 10.0 microns (range 4.7-43.0 microns; average 11.9 microns); the distributions of values indicated bimodality. Most cells had a long:short ratio (L:S ratio) value between 1.00 and 1.80, but 11.9 +/- 6.1% of the cells had L:S ratios between 1.80 and 4.60. The overall relationship between the longest dimension and the area of the cells was nonlinear, with cells having larger L:S ratios having disproportionately smaller areas. CONCLUSIONS: The superficial conjunctival cells are small, and their longest dimensions are systematically related to area. Analyses of cell shape indicate further possible ways of identifying different cells on the bulbar conjunctiva. Compared to literature values, there is a substantial overlap in longest dimensions of the conjunctival cells with those of cells that can be collected off the corneal surface. This means that superficial conjunctival and corneal cells cannot be distinguished simply on the basis of measurements of the long dimension.
Scanning electron microscopy (SEM) of the cellular surface of the rabbit conjunctiva show the monotonous appearance of fine, finger-like cytoplasmic protrusions (microvilli) covering the polygonal cells. Many of these surface cells contained a variety of intracytoplasmic vesicles, unroofed vesicles, and full-thickness holes of different sizes. These surface changes were interpreted as occuring in a sequential pattern leading to cell destruction and exfoliation. Interspersed among these light and dark polygonal cells were goblet cells representing various stages in their maturation. Specialized filopodia were found between epithelial cells only in the area just proximal to the tarsi. Duct openings of many glands were shown to enter onto the conjunctival surface. The relation of these finding to the tear film is discussed.
The clinical and histological features of three cases of conjunctival balloon cell nevi are described. This peculiar form of nevus is very rare in the conjunctiva. The findings are compared with the descriptions in the literature of dermal balloon cell nevi. They demonstrate, that the conjunctival and dermal tumours are of idential histological structure. The proliferations of the conjunctival epithelium often found in conjunctival nevi do not modify the balloon cell nevi. These can not be diagnosed clinically. The problems of the pathogenesis of the balloon cell nevi are discussed.
Granuloma pyogenicum or telangiectatic granuloma is an unusual clinical lesion which may occur anywhere on the body, but on rare occasions presents with ocular manifestations. Its occurrence on the lids has been reported in several instances, but few cases of isolated conjunctival changes have been documented. The purpose of this paper is to present a previously unreported case of histologically proven bilateral granuloma pyogenicum of the conjunctiva and to alert other ophthalmologists as to its significance in the differential diagnosis of conjunctival masses.
PURPOSE: To compare the effect of timolol with or without preservatives on the conjunctival epithelium of glaucoma patients. METHODS: A retrospective study using impression cytology (IC) was conducted on patients treated with 0.5% timolol with or without 0.01% benzalkonium chloride (BAC). Fifteen eyes from 15 patients treated with timolol, BAC+ and 17 eyes from 17 patients treated with timolol, BAC- were included in two groups comparable for age and duration of treatment lasting at least 1 year. Specimens were analyzed by flow cytometry for inflammatory profile (using antibodies directed against HLA DR and ICAM-1) and mucin detection (anti-M1/MUC5AC antibody). RESULTS: IC analyses showed a significant increase in the expression of the two inflammatory markers, HLA DR and ICAM-1 in the timolol, BAC+ group and also a significant decrease in goblet cell density in the same group as compared to the timolol, BAC- group. CONCLUSION: The use of long-term preserved beta-blocker in glaucoma patients is associated with a direct subclinical epithelial toxicity in the conjunctiva, as already demonstrated by previous experimental studies.
This study deals with the development of the human conjunctival goblet cells. Fifty-six eyes of human embryos and fetuses ranging from 5 to 41 weeks of gestational stage were used. The distribution of glycosaminoglycans in the goblet cells was investigated with 1% alcian blue (pH 2.5) staining. For identifying the types of glycosaminoglycans, enzyme digestion methods were carried out with streptomyces hyaluronidase, chondroitinase AC, chondroitinase ABC, or sialidase (neuraminidase). At 9 weeks of gestational age, goblet cells appeared in the fornix region of the conjunctiva and extended toward the palpebral and bulbar regions. Histochemical studies with enzyme digestion methods revealed the existence of sialomucin in the goblet cells from 9 weeks. This finding suggested that the goblet cells first appeared in the fornix area, extending toward the palpebral region, then toward the bulbar region, and containing sialomucin from their early stage of development.
A study was performed on 60 patients, of whom 20 had the dry eye syndrome, 20 had had cataract surgery and 20 belonged to a control group. Twenty percent of the dry eye group and 45% of the post-cataract surgery group had cells with so-called bar-shaped nuclear chromatin (bar-chromatin cells) with a morphology basically akin to those of Anitschkow nuclear changes found in cardiac tissue. Bar-chromatin cells were found in scrapings from different parts of the conjunctiva, mostly in intermediate squamous cells and rarely in goblet cells. However, these nuclear changes were infrequent in the control group. Since the bar-chromatin cells were much more frequent in patients with diseased eyes, we concluded that the findings were possibly of a regenerative nature.
A 65-year-old male patient presented with a rapidly increasing mass in his left eye. It did not show any intra-ocular extension as examined by slit lamp, gonioscopy, indirect ophthalmoscopy and ultrasonography, nor there was any sign of systemic metastasis. The mass was excised completely. Buccal mucous membrane grafting was done to cover up the lower forniceal area and conjunctival autograft taken from right eye and placed over upper fornix and bulbar area. Postoperative radiotherapy was suggested. Histopathological examination of the mass revealed the diagnosis of malignant melanoma of conjunctiva.
Maternal vaginal and neonatal conjunctival flora were prospectively studied in a 117 mother baby pairs. The commonest isolates from both vaginal and conjunctival flora were E. coli, Staphylococcus aureus and Klebsiella species. In 85% of mother-baby dyads, isolates from vagina and conjunctiva were similar. The commonest bacterial isolates in neonates with conjunctivitis were Staphylococcus aureus (37.4%), E. coli (27.9%) and Klebsiella species (19.3%). Maternal coitus, infections, rupture of membranes and baby's birth weight and sex did not influence the occurrence of conjunctivitis.
OBJECTIVE: To evaluate the diagnostic value of polymerase chain reaction (PCR) performed on vitreous, aqueous and conjunctiva for the detection of cytomegalovirus in AIDS patients with a clinical diagnosis of cytomegalovirus retinitis. MATERIAL AND METHOD: PCR-based assay was used to detect cytomegalovirus DNA in vitreous, aqueous and conjunctival samples from 24 patients with the acquired immunodeficiency syndrome (AIDS) who had untreated clinically diagnosed cytomegalovirus retinitis and from 15 immunocompetent patients, including 11 with retinal detachment, 2 with macular hole and 2 with vitreous hemorrhage. RESULTS: Cytomegalovirus DNA was detected in 16, 9 and 3 of 24 vitreous, aqueous and conjunctival samples, respectively, from patients with AIDS, untreated clinically diagnosis of cytomegalovirus retinitis; and in one patient out of 15 vitreous, aqueous and conjunctival samples from immunocompetent patients with vitreoretinal diseases. CONCLUSION: The use of PCR in the detection of cytomegalovirus in vitreous, aqueous and conjunctival samples had an equal specificity of 93% and had sensitivity of 67, 37 and 12%, respectively.
OBJECTIVE: To ascertain the efficacy of Lodoxamide 0.1 in the reduction of Clinicopathological signs of the conjunctiva in Vernal Keratoconjunctivitis. STUDY DESIGN: Prospective, non-comparative, Convenient Interventional Case Series. PARTICIPANTS: One Hundred consecutive patients; 57 males and 43 females within age range 2-55 years diagnosed with active and untreated Vernal conjunctivitis were enrolled. Approval was obtained from Ethical committee of Lagos University Teaching Hospital, Idi- Araba, Lagos. METHODS: Patients were given a bottle of Lodoxamide 0.1 each to instill four times daily into both eyes. Pre-treatment Clinical photographs and conjunctival biopsies were taken in 15 volunteered patients. Ocular signs and symptoms were evaluated on day 1 (baseline), days 2-3 (Interim) and then weekly for 6 weeks (final). Post treatment Clinical photographs and conjunctival biopsies were done at the 6th week. The conjunctival tissues were fixed for 24 hours in 10 Neutral buffered formalin prior to paraffin wax embedding and routinely stained with Haematoxylin and Eosin (H & E) stains. MAIN OUTCOME MEASURE: Primary outcome was based on the reduction of inflammatory cells especially the eosinophils on histological micrographs. Secondary efficacy was based on the rate and extent of reduction of the severity scores of the clinical signs and symptoms. RESULTS: Lodoxamide 0.1 ophthalmic solution significantly reduced the density of the inflammatory cells especially eosinophils in the post treatment conjunctival biopsy cytology specimen. The mean physician severity scores for signs and symptoms consistently reduced from 72 hours of commencement of Lodoxamide with remarkable improvement in a week and complete resolution of all parameters at the end of 5th week. CONCLUSION: Lodoxamide 0.1 ophthalmic solution is highly effective in alleviating the clinical signs and symptoms of Vernal Keratoconjunctivitis and its antiallergic activity is exerted by inhibiting migration of inflammatory cells mainly eosinophlis.
UNLABELLED: There is no ideal culture establishing method for the conjunctival sac reconstruction. Two methods of primary conjunctival culture establishing were compared. MATERIALS AND METHODS: The internal surface of rat's eyelid was used. In the 1st method cells migrate from specimen and attached to the surface of culture plate. In the 2nd method tissue was digested and placed in the flask. Epithelial character of cultured cells was confirmed. RESULTS: Both methods allow to set up the culture of epithelial cells. Efficiency of enzymatic isolation was higher then growing from previously attached specimen. At the end of the experiment the cultures were similar. CONCLUSIONS: Both methods allow to establish the primary culture of conjunctival epithelial cells. Eyelid conjunctiva can be a cells source for the conjunctival sack reconstruction purpose.
Conjunctiva-associated lymphoid tissue (CALT) in the eyelids of chickens was studied by gross, histologic, and electron microscopic techniques. Structural features were characterized at 1 day of age and at posthatching week (PHW) 1, 2, 3, 4, 6, 8, 12, and 16. Beginning at PHW 1, prominent lymphoid nodules containing a heterogenous population of lymphocytes, lymphoblasts, and macrophages were first observed within conjunctival folds and fissures of the lower eyelid. Nodules contained germinal centers by PHW 2 and plasma cells by PHW 4. The epithelium associated with these nodules was flat, had short, irregular microvilli, contained intraepithelial lymphocytes, and lacked goblet cells. High endothelial venules were located at the base of lymphoid nodules and contained lymphocytes within and below the cuboidal endothelium. In the upper eyelid, CALT was morphologically similar to lymphoid tissue in the lower eyelid, but nodules were smaller and more random, lacked association with epithelial folds and fissures, and were clustered around the opening of the nasolacrimal duct. By PHW 12, CALT was characterized by basal germinal centers outlined by collagenous stroma, suprafollicular plasma cells, columnar epithelium with goblet cells, and fewer intraepithelial lymphocytes. On the basis of these features, CALT in chickens has morphologic characteristics similar to other components of the mucosal immune system and, therefore, may have a role in mucosal immunity.